Clinician perspectives on psychodynamic psychotherapy with experienced clients

Despite the large proportion of clients who use psychotherapy more than once in their lifetimes, little empirical, theoretical, or technical literature focuses on conducting subsequent therapy. This qualitative study used in-depth interviews of 8 experienced doctoral-level psychologists (all with over 15 years experience conducting therapy) to examine the process of conducting psychotherapy with experienced clients. Psychotherapists in the sample were all trained with a psychodynamic or psychoanalytic orientation and continued to work partially or exclusively in that tradition. Results include analysis by interviewee including presentation of specific cases, as well as thematic analysis across interviewees. Thematic analysis is divided into three sections: classifications of subsequent therapy in relation to previous therapy, practice considerations and recommendations, and therapists\u27 subjective experience and beliefs about experienced clients and subsequent therapy. Findings relate to issues of mental health service utilization such as help-seeking and intermittent use of psychotherapy throughout the life cycle. Findings also address psychotherapy process issues such as beginning the treatment, therapist-directed exploration of previous therapy, deciding whether to contact previous therapists, working with clients\u27 unresolved feelings from previous therapy, making therapeutic use of talking about previous therapy, working with clients who return to the same therapist, and triangulation of previous therapist, subsequent therapist, and client. Therapy with experienced clients was found to be different from therapy with inexperienced clients in certain cases; however, in generalizing about their practices as a whole, the therapists interviewed judged these differences to be small in comparison with other client characteristics affecting therapy